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Renal and urology > Kidney diseases > Flashcards

Kidney diseases Flashcards

1
Q

What is glomerulonephritis?

A

Non-infective inflammation of the glomeruli of the kidney, often with an immunological cause

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2
Q

What is pyelonephritis?

A

Bacterial infection of renal pelvis, calyces, tubules and interstitium

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3
Q

What is the most common causative organism of pyelonephritis?

A

E. coli

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4
Q

Which gender is pyelonephritis more common in?

A

Female

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5
Q

How does pyelonephritis occur?

A

Infection from haematogenous spread

Ascending infection

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6
Q

What are the risk factors for pyelonephritis?

A

Urinary tract obstruction

Vesico-ureteric reflux

Diabetes

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7
Q

What would indicate chronic pyelonephritis

A

Symptoms often vague

Hypertension/uraemia

Large volume of urine

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8
Q

What would be seen on imaging of the kidney in chronic pyelonephritis?

A

Coarse cortical scarring

Distortion of calyces

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9
Q

What is chronic pyelonephritis associated with?

A

Chronic kidney disease

Hypertension

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10
Q

What are the symptoms of tubercular pyelonephritis?

A

Weight loss

Fever

Loin pain

Dysuria

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11
Q

How does tuberculosis normally reach the kidney?

A

Haematogenous spread from lung

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12
Q

What is sterile pyruria and what disease does it occur in?

A

Tubercular pyelonephritis

Pus in urine, but doesn’t grow organisms on culture because TB takes weeks to grow in special medium

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13
Q

What pathology might be seen in tubercular pyelonephritis?

A

Caseous foci – slow growth with progressive renal destruction

Spread to ureters, bladder and other viscera

Typical caseating granulomatous inflammation

Mycobacteria may be seen on histological special stains (Zeehl-Neilsen) but absence does not exclude TB

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14
Q

What bacteria cause cystitis?

A

E. Coli.

Klebsiella

Proteus

Pseudomonas

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15
Q

What is cystitis?

A

Inflammation of the bladder caused by a urine infection

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16
Q

Why is cystitis associated with outflow obstruction particulary dangerous?

A

Can become necrotising if associated with outlet obstruction

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17
Q

What is ureteritis/cystitis cystica?

A

Multiple small fluid filled cysts projecting into lumen as a result of chronic inflammation/irritation

Can resemble tumours

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18
Q

What organism can predispose to malignancy, particularly squamous cell carcinoma of the bladder?

A

S. Haematobium - schistosomiasis

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19
Q

What can be a result of prolonged bladder outlet obstruction?

A

Hypertrophy of the detrusor muscle, which can cause diverticular formation

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20
Q

Which problem in neonates can cause urethral outflow obstruction?

A

Posterior urethral valves

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21
Q

What is hydronephrosis?

A

Dilatation of pelvicalyceal system with parenchymal atrophy

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22
Q

What are the main causes of hydronephrosis?

A

Urinary tract obstruction

Reflux

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23
Q

What is this?

A

Hydronephrosis

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24
Q

What is the most common cause of urinary outflow obstruction in the elderly male?

A

Prostatic enlargement or tumour

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25
Q

What is the inheritance pattern of adult polycystic kidney disease?

A

Autosomal dominant

Abnormality on chromosome 16

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26
Q

How does adult polycystic kidney disease usually present?

A

Middle age

Abdominal mass

Haematuria

Hypertension

Chronic renal failure

Fatigue

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27
Q

What are the pathological characteristics of adult polycystic kidney disease?

A

Massive bilateral renal enlargement

Multiple cysts of varying size

Distortion of reniform shape

Cysts arise in any part of nephron

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28
Q

What other extrarenal complications is adult polycystic kidney disease associated with?

A

Cysts in liver, pancreas, lung

Association with berry aneurysm in the circle of Willis

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29
Q

What is the significance of increased risk of berry anuerysms associated with polycystic kidneys?

A

Increased risk of subarachnoid haemorrhage

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30
Q

Where are fibroma found in the kidney and what is their appearance?

A

Medulla

White nodules

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31
Q

Where are adenoma found in the kidney and what is their appearance?

A

Cortex

Yellowish nodules <2cm

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32
Q

What is angiomyolipoma and where might they be in the kidney?

A

Mixture of fat, muscle and blood vessels

Can be multiple and bilateral

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33
Q

What disease is angiomyolipoma associated with?

A

Tuberous sclerosis

34
Q

How might a juxtaglomerular cell tumour present?

A

Secondary hypertension due to increased renin

35
Q

What is the most common intra-abdominal tumour in children and from which tissue does it arise?

A

Nephroblastoma (Wilms’ Tumour)

Arises from residual primitive renal tissue

36
Q

What is the commonest primary renal tumour in adults?

A

Renal cell carcinoma

37
Q

What age and gender does renal cell carcinoma usually present in?

A

Age 55-60

M:F 2:1

38
Q

How does renal cell carcinoma present?

A

Abdominal mass

Haematuria

Flank pain

General features of malignant disease

39
Q

What are the paraneoplastic manifestations of renal cell carcinoma?

A

Polycythaemia (overproduction of red blood cells)

Hypercalcaemia

40
Q

Where do renal cell carcinomas arise and what is their appearance?

A

Large, well circumscribed mass on the cortex

Yellow colour, with solid, cystic, necrotic and haemorrhagic areas

41
Q

Where do renal cell carcinomas commonly extend into?

A

Renal vein

Can continue into vena cava and right atrium

42
Q

How does renal cell carcinoma usually spread and to where?

A

Through blood

To lung and bone

43
Q

What is the most common cell type in renal cell carcinoma and what are these cells?

A

Clear cell

Tumour cells rich in glycogen and lipid

44
Q

Which type of carcinoma affects the renal pelvis?

A

Transitional cell carcinoma

45
Q

What imaging is used to diagnose renal cell carcinoma?

A

Ultrasound
Triple phase contrast CT

46
Q

What system is used to stage renal cell carcinoma?

A

Robson staging

47
Q

What surgical treatments are there for renal cell carcinoma?

A

Radical nephrectomy

Partial nephrectomy

Radiofrequency ablation

48
Q

What is the definition of chronic kidney disease?

A

Chronically reduced GFR and evidence of kidney damage

49
Q

How can GFR be estimated?

A

Creatinine clearance

50
Q

Why is creatinine clearance only an estimate of GFR?

A

Secreted from tubules

Increased in muscular people

Needs to be stable - fluctuates during illness in hospital

Requires 24 hour urine collection which is often done inaccurately

51
Q

What is the definition of stage 1 chronic kidney disease?

A

GFR > 90ml/min with evidence of kidney damage

52
Q

What is the definition of stage 2 chronic kidney disease?

A

GFR 60-90ml/min with evidence of kidney damage

53
Q

What is the definition of stage 3 chronic kidney disease?

A

GFR 30-60ml/min

(1 in 20 people will have a GFR like this normally)

54
Q

What is the definition of stage 4 chronic kidney disease?

A

GFR 16-30ml/min

55
Q

What is the definition of stage 5 chronic kidney disease?

A

GFR <15ml/min or renal replacement therapy

56
Q

Which factors indicate that someone is more likely to progress to a higher stage of chronic kidney disease?

A

Proteinuria

Younger age at onset

57
Q

What is the most common cause for requirement of dialysis?

A

Diabetic nephropathy

58
Q

What are the common causes of CKD?

A

Diabetes

Hypertension

Vascular disease

Chronic glomerulonephritis

Reflux nephropathy

Polycystic kidneys

59
Q

When do symptoms usually present in chronic kidney disease?

A

Late: GFR usually <20ml/min

60
Q

What are the symptoms of chronic kidney disease?

A

Tiredness

Poor appetite

Itch

Sleep disturbance

Impaired urinary concentrating ability – symptoms may occur earlier - nocturia

61
Q

How is progression of CKD slowed?

A

Reducing proteinuria and managing blood pressure:

ACEi/ARBs do both

Spironolactone

Stopping smoking

Managing diabetes

62
Q

What side effects must you be aware of when starting a patient on ACEi or spironolactone for CKD?

A

Initial fall in GFR

Hyperkalaemia

63
Q

Why does anaemia occur as a side effect of CKD?

A

Erythropoietin produced by the kidneys and production declines in CKD

64
Q

Why is bone disease a complication of CKD?

A

Vitamin D hydroxylated in the kidney - impaired in CKD
Leads to reduced calcium absorption, leading to secondary hyperparathyroidism

In advanced CKD, serum phosphate rises – also increases PTH secretion

65
Q

What can result from high phosphate and high calcium?

A

Calcified vessels and heart valves

66
Q

How is bone disease treated in relation to CKD?

A

Alfacalcidol

Advice on phosphate intake

Phosphate binders

67
Q

What is reflux nephropathy?

A

Angles of the ureters fail to shut the valves properly, causing reflux

Kidneys become small and scarred due to vesico-ureteric reflux

Sometimes called chronic pyelonephritis

68
Q

Which patients is reflux nephropathy most common in?

A

Children

69
Q

When do hepatic cysts associated with polycystic kidneys tend to arise?

A

10 years after kidney disease

70
Q

What cardiac disease is associated with polycystic kidney disease?

A

Mitral/aortic valve prolapse

Valvular disease

71
Q

What GI disease is polycystic kidney disease associated with?

A

Diverticular disease

Diverticulitis and perforation are 2 important complications

72
Q

How should polycystic kidney disease be managed?

A

Rigourous control of hypertension

Hydration

Proteinuria reduction

73
Q

Where are cysts seen coming from in autosomal recessive polycystic kidney disease?

A

Seen appearing from the collecting system

74
Q

Which pattern of inheritance is Alports syndrome?

A

X-linked recessive

75
Q

What is Alports syndrome?

A

An inherited nephritis caused by a defect in type IV collagen matrix

76
Q

What are the renal manifestations of Alports syndrome?

A

Haematuria initially

Proteinuria later

77
Q

What renal manifestation is a bad prognostic sign in Alports disease?

A

Proteinuria

78
Q

What are the extra-renal manifestations of Alports syndrome?

A

Sensorineural deafness

Ocular defects-anterior lenticonus

Leiomyomatosis of oesophagus/genitalia-rare

79
Q

What is the characteristic feature on biopsy of Alports syndrome?

A

Variable glomerular basement membrane thickness

80
Q

What is Anderson-Fabrys disease?

A

An X linked disease lysosomal storage disease affecting kidneys, liver, lungs and erythrocytes

Renal and urology (11 decks)

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